Appendix 3: SPCM Scoring Form SEATED POSTURAL CONTROL MEASURE January 1994 SUNNY HILL HEALTH CENTRE FOR CHILDREN 3644 Slocan Street, Vancouver, B.C. V5M 3E8 Yr Mo Day Score Min Max. Name Date of Assessment Alignment 34 48 I.D. No_ Date of Birth Diagnosis_ Chronological Age Function 12 48 Date of onset of problem_ Rater Name Referring physician LEVEL OF SITTING SCALE Check category below (see Guidelines) 1 unplaceable 2 supported from head downward 3 supported from shoulder or trunk downward 4 supported at pelvis 5 maintains position, does not move 6 shifts trunk forward, re-erects 7 shifts trunk laterally, re-erects 8 shifts trunk backwards re-re-erects COGNITIVE LEVEL Understands most instructions Understands few instructions COOPERATION LEVEL Cooperates fully Cooperates with prompting Uncooperative Description of Seating System used for this test: Date last modified: / / Is present fit adequate? Yes No Type of system and general comment: Indicate seating system in degrees: Interface surface seat to back angle planar angle of seat back recline related to vertical plane (tilt in space) contour Check seating system components which are present: Pelvis: Trunk: Head and Neck pelvic stabilizer lateral thoracic support circumfrential head and neck support ASIS pads lumbar support head support pelvic bar anterior trunk support posterior pelvic belt at shoulder anterior safety belt chest panel lateral lateral support posterior neck support Thigh: Knees Upper Limbs medial support anterior support tray lateral support custom arm supports posterior blocks scapulae Page 1 of 6 elbows
Appendix 3: SPCM Scoring Form (cont d) SEATED POSTURAL CONTROL MEASURE Sunny Hill Health Centre for Children, Vancouver, B.C FUNCTION SECTION Circle score for each item. Administer items 1 & 2 simultaneously, score separately. 1. Lifts head upright and maintains 5 sec If child s head is not flexed forward prior to test, instruct or assist child to do so. Upright position of the head is defined as that position where central gaze is directed along the horizontal plane (+/- 15º in saggital plane). 1. does not initiate head lift 2. initiates a head lift 3. lifts head, does not attain upright, but holds for 5 sec 4. lifts head upright and maintains for 5 sec 2. Lifts head upright, in midline and maintains for 10 sec If child s head is not flexed forward prior to test, instruct or assist child to do so. Midline position of the head is defined as that position where central gaze is directed along the horizontal plane (+/- 5 º in coronal plane). 1. does not initiate head lift 2. initiates head lift but does not attain midline 3. attains midline but maintains for less than 10 seconds 4. lifts head to midline and maintains for 10 seconds 3. Leans forward, touches toy with preferred wrist or hand, re-erects Place board 6" from child s stomach. Small toy placed on board at child s midline at a distance 1 arm length. 1. does not lean forward and re-erect 2. leans forward but does not touch toy 3. leans forward, touches toy, but does not re-erect 4. leans forward, touches toy, re-erects 4. Leans forward and to right or left, touches toy with OPPOSITE hand, re-erects The intent of this item is to obtain trunk rotation; either hand may be used. Small toy placed on board in front of child on the side opposite to the reaching hand. Place toy 1 arm length of the reaching arm along the layout guide marker line, which runs 60 degrees from trunk midline. 1. does not move trunk 2. lean towards toy but does not touch it 3. leans towards and touches toy with hand, does not re-erect 4. leans towards and touches toy with hand, re-erects 5. Lifts both upper limbs free of support 1. does not lift either upper limb off support 2. lifts RIGHT or LEFT upper limb off support for less than 3 sec 3. lifts one upper limb off support for 3 sec 4. lifts both upper limbs off support for 3 sec Page 4 of 6
Appendix 3: SPCM Scoring Form (cont d) 6. Reaches forward, grasps and releases toy with preferred hand Small toy placed on board an arm length anterior to the trunk midline. 1. does not touch toy 2. touches toy with palm or fingers 3. grasps toy and lifts it off board for 3 sec 4. releases toy into large container set down in a convenient place Administer items 7 & 8 simultaneously, score separately. 7. Removes and replaces lid of screw-type jar Jar placed on board anterior to child s midline at any location which accommodates child s attempts to grasp jar. 1. does not touch jar 2. places one or both hands on jar 3. unscrews and removes jar lid 4. replaces jar lid and screws it closed 8. Picks up raisin (or cheerio), places into mouth with preferred hand Raisin placed on board at any location which accommodates child s attempts to pick up raisin. 1. does not touch raisin 2. touches raisin with tips of fingers and/or thumb 3. picks up raisin and holds for 3 sec 4. releases raisin into mouth 9. Picks up pen makes mark on paper Pen and 81/2" x 11" sheet of paper placed midline on board, pen tip pointing towards child. 1. does not grasp pen 2. grasp pen with one or both hands 3. grasp and lifts hand and/or pen clear of surface 4. marks paper with pen 10. Places dice in jar, one at a time, with preferred hand, in 30 sec Place one die and jar on board as indicated by paper guide immediately in front of child. Request child to place dice into jar, one at a time, using one hand, as fast as possible. Assessor to place next dice on paper guide while child is placing previous dice in jar. (Do not hinder child s performance). 1. does not place any dice in jar 2. places 1 die 3. places 2 to 5 dice 4. places 6 dice Page 5 of 6
Appendix 3: SPCM Scoring Form (cont d) 11. Moves his/her wheelchair forward 45' in less than 20 sec Allow one practice trial to ensure child understands task 1. unable to move wheelchair forward 2. moves wheelchair forward 10' in less than 60 sec 3. moves wheelchair forward 45' in less than 60 sec 4. moves wheelchair forward 45' in less than 20 sec 12. Moves his/her wheelchair forward 19' along a 8' wide corridor, turns right or left 90 degrees and passes through 33' doorway Allow one practice trial to ensure child understands the task. Maximum of 60 seconds allowed for completion of the task 1. does not move wheelchair forward 10' without bumping into walls 2. moves wheelchair forward 10', but does not initiate a turn 3. moves wheelchair forward 10', turns and passes through doorway, with wall contact 4. moves wheelchair forward 10', turns and passes freely through doorway TOTAL SCORE FUNCTION_ (Max = 48) Enter score on page 1 Page 6 of 6